How New Cervical Screening Tests Look For HPV

HPV causes over 90% of cervical cancers. This link was discovered by the German virologist Harald zur Hausen in the 1970s / early 80s. He later won the Nobel Prize for his work. International evidence has shown that HPV screening is the best way to perform cervical screening. This program took three years to develop in Ireland. Dr. Price says he learned from the experience of countries such as Wales, Australia and the Netherlands.

High-risk HPV check

Dr. Kaitriona Henchion, Medical Director of the Irish Family Planning Association, said the HPV cervical examination, as well as the new one, needs explanation. “Women receive an information sheet before they come to the screening, but they often arrive without information. The explanation can take a considerable amount of time.”

The major changes are: HPV is currently the primary test for cervical screening – women are first tested for one of the high-risk types of HPV. The big players are HPV 16 and 18 – according to the Irish College of General Practitioners (ICGP), it is estimated that about 4.3% of women in the general population carry these strains at any time – and also the cause of cervical cancer. An additional panel of strains. If HPV is found, the same sample will be checked for abnormal cells.

If these were found, the woman was referred to the hospital for colposcopy (a procedure for checking for abnormal cervical cells) and, if necessary, treatment.

If HPV is not found, there is no abnormal cell check. Without HPV, the risk of developing cervical cancer is very low.

If the new HPV test is HPV-positive in women but there are no abnormal cellular changes, they will be recalled the following year for further testing. “If we were looking only for abnormal cells, as in the past, the woman would have been placed at regular callback intervals of 3 to 5 years. But in the new screening, she had abnormal cell changes. She will be called back within a year because she knows she is infected with HPV, which has a slightly higher risk of developing the disease, “explains Dr. Henchion.

But what about a woman who says, “I don’t know how long it’s been since I got infected with HPV.” Can you afford to wait a year? Do I need to see a gynecologist right away? Dr. Noirín O’Herlihy, director of women’s health at ICGP, said it takes a long time for cervical cancer to develop after the first HPV infection. “In most cases, it takes 10 to 15 years for cervical cancer to develop,” Dr. Hention said to Colposcopy if a woman does not undergo abnormal cell changes the following year but is HPV-positive. I will point out that it will be done.

In the old system (prior to March 2020), the smear test first looked for abnormal cells in the cervix. If found, women were usually treated with colposcopy to remove these cells. HPV screening was then performed to confirm that the treatment worked. However, most abnormal cells return to normal on their own. Even if a woman is not infected with HPV, there is little risk of developing cancer. This means that some people have been treated with colposcopy when they don’t need it.

Dr. Henchion states that HPV screening is a very welcome development. “Cytology [smear testing] Manual test – The technician will check every slide. There is always the possibility of human error. HPV inspection is a more automated system with less chance of error. She also says that being HPV-negative can more accurately predict the risk of developing cervical cancer than detecting mildly abnormal cells.

The HPV test is not a diagnostic test for cervical cancer. Measures the risk of developing the disease. Like most screening tests, it’s not perfect. Despite regular screening, some women develop cervical cancer. However, HPV screening detects 15% more cases of cervical cancer than smear tests. For every 1,000 women screened, 20 women have abnormal (precancerous) cervical cells, so HPV screening detects 18 of these 20 women, while smear tests 15 The person is detected. “Traditional screening detected 75% of cervical cancers. HPV tests scored 90%. Not 100%, but better,” says Dr. Price.

For women, the actual experience of HPV screening is no different from traditional smear testing. However, women between the ages of 30 and 44 will be screened every 5 years instead of every 3 years. The same interval applies to women aged 45-65, but women aged 25-29 are screened every three years.

CervicalCheck has announced the results of more than 107,000 HPV screening tests conducted in primary care between July 2020 and the end of January 2021. HPV was detected in over 13,000 samples. Since HPV is a skin-to-skin virus acquired during sexual contact, the peak time for new infections is in the twenties. When most people start to become sexually active. “When people change partners in later life, it may also be detected from it,” says Dr. Henchion.

According to Dr. Price, at least 40% of women under the age of 25 will be infected with HPV at some stage. One in four women by the age of 25 is HPV positive, but the proportion of women between the ages of 35 and 50 drops to 10%. “For the majority of these women, their own immune system clears it-they become HPV negative within 18 months to 2 years.”

Continuous monitoring

Generally, 14,000 women are referred for colposcopy each year, and about 4,000 need treatment. HPV-positive women with abnormal cellular changes are evaluated at the colposcopy clinic to see if the changes are mild, moderate, or severe. Mild changes may resolve spontaneously – women will be rechecked after 6-12 months. If the changes are moderate or severe, she will be treated to remove the abnormal cells.

“Six months after treating these cells, we will retest to see if HPV is cleared. With HPV gone, the chances of returning are less than 5%,” said Dr. Price. Says.

In some parts of London, a pilot-based HPV self-sampling study, in which women test for HPV at home, began in January. It may seem like a good option for women who are too busy or too embarrassed to go to the GP, but a CervicalCheck spokeswoman said the sample can only be used to test HPV. I am. If a woman is HPV positive, further screening is needed. Her doctor checks for abnormal cells. “And there is no evidence yet [self-sampling] It’s an accurate or cost-effective method. “

CervicalCheck’s screening program has reached nearly 80% of eligible women in recent years, but the target range for international programs currently using self-testing is less than 60%. “The best study came from the Netherlands and tried to reach women who didn’t accept regular test invitations. They provided a home test kit and got 35% adoption,” said Dr. Price. He added that the home test kit has not yet been internationally evaluated or recommended.

When Dr. Hention calls a woman with HPV-positive news, she is naturally a little upset, especially if there are abnormal cell changes. “Most people think their tests will be negative. When they are shown, they feel almost over.”

She says her job is to turn what seems bad into something positive. “Explain that it’s really good that they came. They may not have been continuously tested, but instead this was detected really early and manageable. And explain that if they need to go to a hospital / clinic, they may not even need treatment. If so, the treatment is done as an outpatient and very much in the prevention of cervical cancer. I’m successful. “

Emotional impact of the test

Dr. Mairead O’Connor is a researcher at the UCC School of Public Health and a researcher at the CERVIVA Consortium investigating HPV-related diseases. In 2012 / ’13, with Professor Linda Sharp, she conducted a detailed face-to-face interview with 27 women at the Colposcopy Clinic at the Dublin Maternity Hospital. A pilot study (exa.mn/ImpactHPVtesting) examined the emotional effects on women undergoing HPV testing in the post-treatment situation of abnormal cell changes.

“Women’s concerns about abnormal cell changes and fear of developing cancer far outweighed their concerns about HPV,” said Dr. O’Connor.

She remembers a woman saying: “It doesn’t matter if it’s HPV or ABC, I just want to know if it’s cancer.” However, some women experienced worries, fears, and anxieties about being HPV positive. “Some people were worried about the possibility of unfaithful relationships. The partner could have been unfaithful and that’s how they got infected with HPV. Some people felt shame and stigma. They were people. I didn’t tell anyone about the diagnosis because I don’t want them to think too much about them. “

Dr. O’Connor provided insights on the best way to convey an HPV-positive diagnosis to women and found that women who knew the prevalence of HPV in the population were depressed in 2007. It also cites a British study (exa.mn/HPVStigma). Levels of Stigma, Shame, or Anxiety – Those who do not know it is very prevalent, but who know it is a sexually transmitted disease, are more likely to have a higher score for stigma and shame. ..

Dr. O’Connor points out that CervicalCheck has done a lot of training for GP / practicing nurses to discuss HPV with women and states that it is about normalizing HPV infection. Most people get infected at some point in their lives. “It is also important to talk about HPV screening in the context of cervical screening, not in the context of STI. This minimizes anxiety and worry about the possibility of HPV infection.”

Dr. Price says that when cervical cancer is found by screening, it is almost always detected early, easier to treat, and easier to cure. Unfortunately, in Ireland, only half of cervical cancers are found by screening. Dr. Price states that 80% of women participate in the screening and 50% of cervical cancers not found in the screening belong to the 20% group who do not participate in the test. “The results are not very good because they are waiting for symptoms.”

In Ireland, the incidence of cervical cancer has decreased over the last 12 years, about half that of pre-screening. “We hope that switching to HPV screening will further reduce the incidence,” said Dr. Price, who started HPV cervical cancer screening in 2017 in the Netherlands, where the incidence of cervical cancer is within five years. He added that he expects a 15% reduction.

Kim Hanly, founder of Cervical Cancer Awareness Ireland, suffers from cervical cancer. She is pleased that HPV cervical screening is currently taking place in Ireland. “It will catch more pre-cancer and cancer. I advise women to go.”

The third wave of Covid-19 means that some GP clinics / community clinics can’t offer appointments for cervical examinations or are out of capacity, but CervicalCheck says women are GPs. / We recommend that you keep in touch with the clinic and rebook as soon as possible. If you are worried about symptoms such as post-sexual intercourse or post-menopausal bleeding, contact your GP immediately.

HPV positive

Offaly-based Niamh *, 25, took her first screening test at the Cervical Check last August. The care assistant, the mother of her 5-year-old son, was HPV positive and had abnormal glandular cells.

“I was confused. I was vaccinated with HPV at school, so I thought I would be protected, but of course when I was vaccinated 10 years ago, the number of HPV strains was so high. There weren’t many. “

She went to colposcopy to investigate the abnormal cells. “They had a biopsy and introduced me for a hysteroscopy [looks inside uterus].. I was sent to an interdisciplinary team to see the best way to treat abnormal glandular cells. “

Abnormal glandular cells develop in the cervical canal and may not appear in cytological samples. They are precancerous changes, not cancer.

“It was 7 o’clock in the evening of December-I was shopping for Christmas-when they said they decided I should get LLETZ treatment [procedure to remove cervical tissue].. I had it 5 weeks ago and am waiting for the results.

“I didn’t feel embarrassed to get HPV. Almost everyone has it at some stage. I had no problem talking to my partner. Abnormal cells Worried me more. I’m lucky because I was told to come back after 3-5 years if HPV didn’t show up. Abnormal glandular cells are rare enough to show up in screening, because it’s not always the case. They said they were lucky to be picked up. “

* Renamed.